Factors Influencing Health Care Utilization in Older Hispanics with Diabetes along the Texas-Mexico Border
Publication: Population Health Management
Volume 15, Issue Number 3
Abstract
Little is known about predictors of health care utilization for older Hispanics with chronic conditions. This study aimed to determine: (1) the level of health care access for older Hispanics with type 2 diabetes living in a US–Mexico border area; and (2) personal and health correlates to health care utilization (ie, physician visits, eye care, emergency room [ER] use). This was a cross-sectional study based on a community assessment conducted at a clinic, senior centers, and colonias. Colonias are impoverished neighborhoods with substandard living conditions along the US–Mexico border. Hispanics living in colonias are one of the most disadvantaged minority groups in the United States. The study sample consisted of 249 Hispanics age 60 years and older who have type 2 diabetes. Descriptive analyses, multiple linear regression, and generalized linear models were conducted. Older age (P=0.02) and affordability of physician fees (P=0.02) were significant correlates to more frequent physician visits. Factors significantly associated with eye care were being insured (P=0.001) and reporting high cholesterol (P=0.005). ER use was significantly associated with younger age (60–64 years old; P=0.03) and suffering from hypertension (P=0.02). Those who received diabetes education (P=0.04) were less likely to use the ER. Identifying patterns of health care utilization services in aging underserved minorities who are disproportionately affected by diabetes may lead to culturally appropriate preventive practices and timely access to health care. Adequate health care access can decrease or delay the onset of diabetes complications in older Hispanics with type 2 diabetes who live along the US–Mexico border. (Population Health Management 2012;15:149–156)
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References
1.
Angel JLWhitfield KE. Setting the stage: Hispanic health and aging in the AmericasAngel JLWhitfield KEThe Health of Aging Hispanics: The Mexican-Origin PopulationNew YorkSpringer2007. 1. Angel JL, Whitfield KE. Setting the stage: Hispanic health and aging in the Americas. In: Angel JL, Whitfield KE, eds. The Health of Aging Hispanics: The Mexican-Origin Population. New York: Springer; 2007.
2.
Prevalence of diabetes among Hispanics—Selected areas, 1998–2002MMWR Morb Mortal Wkly Rep200453941-944. 2. Prevalence of diabetes among Hispanics—Selected areas, 1998–2002. MMWR Morb Mortal Wkly Rep. 2004;53:941–944.
3.
Centers for Disease Control and Prevention. QuickStats: Diabetes death rate for Hispanics compared with non-Hispanic whites—United States versus counties along the U.S.–Mexico border, 2000–2002MMWR Morb Mortal Wkly Rep200655882. 3. Centers for Disease Control and Prevention. QuickStats: Diabetes death rate for Hispanics compared with non-Hispanic whites—United States versus counties along the U.S.–Mexico border, 2000–2002. MMWR Morb Mortal Wkly Rep. 2006:55:882.
4.
Diaz-Apodaca BAEbrahim SMcCormack Vde Cosio FGRuiz-Holguin R. Prevalence of type 2 diabetes and impaired fasting glucose: Cross-sectional study of multiethnic adult population at the United States-Mexico borderRev Panam Salud Publica201028174-181. 4. Diaz-Apodaca BA, Ebrahim S, McCormack V, de Cosio FG, Ruiz-Holguin R. Prevalence of type 2 diabetes and impaired fasting glucose: Cross-sectional study of multiethnic adult population at the United States-Mexico border. Rev Panam Salud Publica. 2010;28:174–181.
5.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitusN Engl J Med1993329977-986. 5. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–986.
6.
Harris CdPan LMukhtar Q. Changes in receiving preventive care services among US adults with diabetes, 1997–2007Prev Chronic Dis20107A56. 6. Harris Cd, Pan L, Mukhtar Q. Changes in receiving preventive care services among US adults with diabetes, 1997–2007. Prev Chronic Dis. 2010;7:A56.
7.
Nwasuruba COsuagwu CBae SSingh KPEgede LE. Racial differences in diabetes self-management and quality of care in TexasJ Diabetes Complicat200923112-118. 7. Nwasuruba C, Osuagwu C, Bae S, Singh KP, Egede LE. Racial differences in diabetes self-management and quality of care in Texas. J Diabetes Complicat. 2009;23:112–118.
8.
Berdahl TA. Access to health care for nonmetro and metro Latinos of Mexican origin in the United StatesMed Care200745647-654. 8. Berdahl TA. Access to health care for nonmetro and metro Latinos of Mexican origin in the United States. Med Care. 2007;45:647–654.
9.
Al Snih SMarkides KSRay LAFreeman JLOstir GVGoodwin JS. Predictors of healthcare utilization among older Mexican AmericansEthn Dis200616640-646. 9. Al Snih S, Markides KS, Ray LA, Freeman JL, Ostir GV, Goodwin JS. Predictors of healthcare utilization among older Mexican Americans. Ethn Dis. 2006;16:640–646.
10.
Robinson SBaron RBCooper BJanson S. Does health service use in a diabetes management program contribute to health disparities at a facility level? Optimizing resources with demographic predictorsPopul Health Manag200912139-147. 10. Robinson S, Baron RB, Cooper B, Janson S. Does health service use in a diabetes management program contribute to health disparities at a facility level? Optimizing resources with demographic predictors. Popul Health Manag. 2009;12:139–147.
11.
Fronczek P. Income, earnings, and poverty from the 2004 American Community Surveyhttp://www.census.gov/prod/2005pubs/acs-01.pdfNovember212010. 11. Fronczek P. Income, earnings, and poverty from the 2004 American Community Survey. Available at: http://www.census.gov/prod/2005pubs/acs-01.pdf. Accessed November 21, 2010.
12.
US Census Bureau. Selected social characteristics: 2005–2009. American Community Surveyhttp://factfinder.census.gov/servlet/ADPTable?_bm=y&-geo_id=05000US48215&-context=adp&-ds_name=ACS_2009_5YR_G00_&-tree_id=5309&-_lang=en&-_caller=geoselect&-format=June232011. 12. US Census Bureau. Selected social characteristics: 2005–2009. American Community Survey. Available at: http://factfinder.census.gov/servlet/ADPTable?_bm=y&-geo_id=05000US48215&-context=adp&-ds_name=ACS_2009_5YR_G00_&-tree_id=5309&-_lang=en&-_caller=geoselect&-format=. Accessed June 23, 2011.
13.
US Census Bureau. Hidalgo County. 2009 American Community Surveyhttp://fastfacts.census.gov/servlet/STTable?-geo_id=05000US48215&-qr_name=ACS_2009_1YR_G00_S2701&-ds_name=ACS_2009_1YR_G00_June262011. 13. US Census Bureau. Hidalgo County. 2009 American Community Survey. Available at: http://fastfacts.census.gov/servlet/STTable?-geo_id=05000US48215&-qr_name=ACS_2009_1YR_G00_S2701&-ds_name=ACS_2009_1YR_G00_. Accessed June 26, 2011.
14.
Ward PMColonia and Public Policy in Texas and Mexico. Urbanization by Stealth1stAustin, TXUniversity of Texas Press1999. 14. Ward PM. Colonia and Public Policy in Texas and Mexico. Urbanization by Stealth. 1st ed. Austin, TX: University of Texas Press; 1999.
15.
Federal Reserve Bank of Dallas. Texas colonias. A thumbnail sketch of the conditions, issues, challenges and opportunitieshttp//www.dallasfed.org/ca/pubs/colonias.pdfNovember52010. 15. Federal Reserve Bank of Dallas. Texas colonias. A thumbnail sketch of the conditions, issues, challenges and opportunities. Available at: http//www.dallasfed.org/ca/pubs/colonias.pdf. Accessed November 5, 2010.
16.
Wong RDiaz JJ. Health care utilization among older Mexicans: Health and socioeconomic inequalitiesSalud Publica de Mexico200749S505-514. 16. Wong R, Diaz JJ. Health care utilization among older Mexicans: Health and socioeconomic inequalities. Salud Publica de Mexico. 2007;49:S505–514.
17.
Pagan JAPuig ASoldo BJ. Health insurance coverage and the use of preventive services by Mexican adultsHealth Econ2007161359-1369. 17. Pagan JA, Puig A, Soldo BJ. Health insurance coverage and the use of preventive services by Mexican adults. Health Econ. 2007;16:1359–1369.
18.
Centers for Disease Control and Prevention. How is BMI calculated and interpreted?http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#InterpretedJune252011. 18. Centers for Disease Control and Prevention. How is BMI calculated and interpreted? Available at: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Interpreted. Accessed June 25, 2011.
19.
Kaushik VPAl Shih SRay LARaji MAMarkides KSGoodwin JS. Factors associated with seven-year incidence of diabetes complications among older Mexican AmericansGerontology200753194-199. 19. Kaushik VP, Al Shih S, Ray LA, Raji MA, Markides KS, Goodwin JS. Factors associated with seven-year incidence of diabetes complications among older Mexican Americans. Gerontology. 2007;53:194–199.
20.
American Diabetes Association. Executive summary: Standards of medical care in diabetes-2010Diabetes Care201033S4-S10. 20. American Diabetes Association. Executive summary: Standards of medical care in diabetes-2010. Diabetes Care. 2010;33:S4–S10.
21.
Centers for Disease Control and Prevention. Percentage of adults aged 18 years or older with diagnosed diabetes receiving a dilated eye exam in the last year, by age, United States, 1994–2009http://www.cdc.gov/diabetes/statistics/preventive/tNewEyeExAgeTot.htmJune252011. 21. Centers for Disease Control and Prevention. Percentage of adults aged 18 years or older with diagnosed diabetes receiving a dilated eye exam in the last year, by age, United States, 1994–2009. Available at: http://www.cdc.gov/diabetes/statistics/preventive/tNewEyeExAgeTot.htm. Accessed June 25, 2011.
22.
Centers for Disease Control and Prevention. Texas—Percentage of adults with diabetes receiving a dilated eye exam in the last year, by age, 1995–2009http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=48&state=Texas&cat=preventive&Data=data&view=A&trend=eyeexam&id=2June252011. 22. Centers for Disease Control and Prevention. Texas—Percentage of adults with diabetes receiving a dilated eye exam in the last year, by age, 1995–2009. Available at: http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=48&state=Texas&cat=preventive&Data=data&view=A&trend=eyeexam&id=2. Accessed June 25, 2011.
23.
Coronado GdThompson BTejeda SGodina RChen L. Sociodemographic factors and self-management practices related to type 2 diabetes among Hispanics and non-Hispanic whites in a rural settingJ Rural Health20072349-54. 23. Coronado Gd, Thompson B, Tejeda S, Godina R, Chen L. Sociodemographic factors and self-management practices related to type 2 diabetes among Hispanics and non-Hispanic whites in a rural setting. J Rural Health. 2007;23:49–54.
24.
Ory MGConkling MBolin JN et al. Sociodemographic and healthcare characteristics of Colonia residents: The role of life stage in predicting health risks and diabetes status in a disadvantaged Hispanic populationEthn Dis.200919280-287. 24. Ory MG, Conkling M, Bolin JN, et al. Sociodemographic and healthcare characteristics of Colonia residents: The role of life stage in predicting health risks and diabetes status in a disadvantaged Hispanic population. Ethn Dis. 2009;19:280–287.
25.
Mier NBocanegra-Alonso AZhan DZuniga MAAcosta RI. Health-related quality of life in a binational population with diabetes at the Texas–Mexico borderRev Panam Salud Publica200823154-163. 25. Mier N, Bocanegra-Alonso A, Zhan D, Zuniga MA, Acosta RI. Health-related quality of life in a binational population with diabetes at the Texas–Mexico border. Rev Panam Salud Publica. 2008;23:154–163.
26.
Schwedes USiebolds MMertes G. Meal-related structured self-monitoring of blood glucose: Effect on diabetes control in non-insulin-treated type 2 diabetic patientsDiabetes Care2002251928-1932. 26. Schwedes U, Siebolds M, Mertes G. Meal-related structured self-monitoring of blood glucose: Effect on diabetes control in non-insulin-treated type 2 diabetic patients. Diabetes Care. 2002;25:1928–1932.
27.
US Department of Health and Human Services Health Resources and Services Administration. Find shortage areas: HPSA by state & countyhttp://hpsafind.hrsa.gov/HPSASearch.aspxJune252011. 27. US Department of Health and Human Services Health Resources and Services Administration. Find shortage areas: HPSA by state & county. Available at: http://hpsafind.hrsa.gov/HPSASearch.aspx. Accessed June 25, 2011.
28.
Puent BDKlein BEKlein RCruickshanks KJNondahl DM. Factors related to vision care in an older adult cohortOptom Vis Sci200582612-616. 28. Puent BD, Klein BE, Klein R, Cruickshanks KJ, Nondahl DM. Factors related to vision care in an older adult cohort. Optom Vis Sci. 2005;82:612–616.
29.
Axer-Siegel RHerscovici ZGabbay MMimouni KWeinberger DGabbay U. The relationship between diabetic retinopathy, glycemic control, risk factor indicators and patient educationIsr Med Assoc J20068523-526. 29. Axer-Siegel R, Herscovici Z, Gabbay M, Mimouni K, Weinberger D, Gabbay U. The relationship between diabetic retinopathy, glycemic control, risk factor indicators and patient education. Isr Med Assoc J. 2006;8:523–526.
30.
Popescu TMota M. Dyslipidemia and hypertension in patients with type 2 diabetes and retinopathyRom J Intern Med200947235-241. 30. Popescu T, Mota M. Dyslipidemia and hypertension in patients with type 2 diabetes and retinopathy. Rom J Intern Med. 2009;47:235–241.
31.
Bazargan MJohnson KHStein JA. Emergency department utilization among Hispanic and African-American under-served patients with type 2 diabetesEthn Dis200313369-375. 31. Bazargan M, Johnson KH, Stein JA. Emergency department utilization among Hispanic and African-American under-served patients with type 2 diabetes. Ethn Dis. 2003;13:369–375.
32.
Fox KmGrandy SShield Study Group. Out-of-pocket expenses and healthcare resource utilization among individuals with or at risk of diabetes mellitusCurrMed Res Opin2008243323-3329. 32. Fox Km, Grandy S; Shield Study Group. Out-of-pocket expenses and healthcare resource utilization among individuals with or at risk of diabetes mellitus. CurrMed Res Opin. 2008;24:3323–3329.
33.
Adler AiStratton ImNeil Ha et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): Prospective observational studyBMJ2000321412-419. 33. Adler Ai, Stratton Im, Neil Ha, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): Prospective observational study. BMJ. 2000;321:412–419.
34.
Lorig KRitter PlVilla FPiette JD. Spanish diabetes self-management with and without automated telephone reinforcement: Two randomized trialsDiabetes Care200831408-414. 34. Lorig K, Ritter Pl, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: Two randomized trials. Diabetes Care. 2008;31:408–414.
35.
Centers for Disease Control and Prevention. BRFSS Annual Survey Data: 2008 BRFSS Data (SAS Transport Format)http://www.cdc.gov/BRFSS/technical_infodata/surveydata/2008.htmMay12011. 35. Centers for Disease Control and Prevention. BRFSS Annual Survey Data: 2008 BRFSS Data (SAS Transport Format). Available at: http://www.cdc.gov/BRFSS/technical_infodata/surveydata/2008.htm. Accessed May 1, 2011.
36.
Lorig KRRitter PLGonzález VM. Hispanic chronic disease self-management: A randomized community-based outcome trialNurs Res200352361-369. 36. Lorig KR, Ritter PL, González VM. Hispanic chronic disease self-management: A randomized community-based outcome trial. Nurs Res. 2003;52:361–369.
37.
Shortell SMGillies RSiddique J et al. Improving chronic illness care: A longitudinal cohort analysis of large physician organizationsMed Care200947932-939. 37. Shortell SM, Gillies R, Siddique J, et al. Improving chronic illness care: A longitudinal cohort analysis of large physician organizations. Med Care. 2009;47:932–939.
Information & Authors
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Copyright
Copyright 2012, Mary Ann Liebert, Inc.
History
Published online: 25 June 2012
Published in print: June 2012
Published ahead of print: 7 February 2012
Authors
Author Disclosure Statement
Drs. Mier, Wang, Smith, Alen, and Ory, and Mr Irizarry, and Ms Treviño disclosed no conflicts of interest. This study was supported by the National Institutes of Health—National Institute of Child Health and Human Development (3 R01HD047143-01S1), the Health Science Center Texas A&M University System Research Development & Enhancement Awards Program, Nuestra Clinica del Valle; the Texas A&M University CHUD Colonias program; the Office of Border Affairs for the Texas Health and Human Services Commission; the Lower Rio Grande Valley Area Agency.
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